Robotic transvaginal natural orifice transluminal endoscopic surgery for bilateral salpingo oophorectomy

Abstract

Robotic transvaginal natural orifice transluminal endoscopic surgery for bilateral salpingo oophorectomy Lior Lowensteina,b,*,1, Emad Matanesa,b,1, Zeev Weinera,b, Jan Baekelandtc a Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel b Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel c Gynecological Oncology and Endoscopy, Imelda Hospital, Bonheiden, Antwerpen, Belgium A R T I C L E I N F O Article history: Received 26 March 2020 Received in revised form 19 June 2020 Accepted 22 June 2020 Available online 23 June 2020 Keywords: Robotic transvaginal surgery Robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES) NOTES Bilateral salpingo-oophorectomy (BSO) Gynecology A B S T R A C T Objectives: The vaginal surgical approach has not become the standard of care, despite its advantages. The HominisTM Surgical System is a humanoid shaped robot-assisted system that was designed specifically for robotic vaginal natural orifice transluminal endoscopic surgery (RvNOTES). We aimed to present our experience with the first RvNOTES bilateral salpingo-oophorectomy (BSO) performed by the Hominis system. Study design: A two-center prospective study of BSO by RvNOTES in women with nonmalignant indications conducted between August and December 2018. Women older than 18 years were offered to participate. Exclusion criteria included a history of abdominal malignancy, pelvic or abdominal irradiation, Crohn's disease, pelvic inflammatory disease, severe infections in the lower abdomen, active diverticulitis, deep infiltrating recto-vaginal endometriosis, and an active vaginal infection. The primary outcome of the study was the rate of conversion to open or laparoscopic approaches. Secondary outcomes included intra- and postoperative adverse events, operative time, estimated blood loss, length of hospital stay, and 6-week follow-up assessment. Results: Eight women aged 50–70 years with BMI of 19–30 kg/m2 were recruited. All the procedures were completed successfully without conversions to open surgery. No intraoperative complications were observed. Median blood loss was 10 mL (range: 10 50). The median duration of the procedure was 45 min (range: 38 91), and decreased over the study period. Surgeons’ usability assessment was very favorable, with a median of 5 on a 1–5 scale. The median visual analog scale (VAS) score was 1 (range: 1– 3). Conclusions: This is the first documentation of a surgery performed via the vagina using robotic instrumentation developed for this purpose. The disruptive technology of RvNOTES, with its fast learning curve, will make gynecological surgeries accessible to more women.